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Ante la emergencia de infecciones relacionadas al drenaje ventricular externo por gérmenes multirresistentes y la necesidad de utilizar antibióticos cuya acción en el sistema nervioso central es controvertida, surge la necesidad de emplear terapéuticas para la administración de fármacos cuyos beneficios merecen ser evaluados. Se realizó una búsqueda de la literatura en PUBMED y los datos fueron extraídos de estudios publicados entre 1987-2005. En esta revisión de la literatura se analizaron los resultados obtenidos, comparando: el tratamiento endovenoso con el tratamiento intratecal en pacientes con infección asociada a la ventriculostomía, los antibióticos utilizados y su penetración al líquido cefalorraquídeo (LCR) con cada vía. Finalmente, se propuso qué pacientes podrían beneficiarse con cada terapéutica, a pesar de la falta de evidencias claras, sugiriendo la necesidad de realizar un trabajo randomizado prospectivo comparando sus beneficios. Palabras clave: infección, tratamiento, ventriculitis.

Due to the emergency of external ventricular drainage infections, cause by multiresistant bacterial strains, and the need to treat them with antibiotics, whose action in the central nervous system is controversial, arises the terapeutic necessity to administer antibiotics whose benefits should be evaluated. We search the Pubmed library. The data were extracted from published studies between 1987-2005. In this reivision the results were analyzed, comparing envovenous versus intrathecal treatment in patients with a ventriculostomy associated infection, the antibiotics that were used and their cerebrospinal fluid (CSF) levels according to each route. Finally, even though there is a lack of clear evidence, we proposed which patients could benefit with each treatment. We conclude that a randomized prospective study, comparing the benefits of each treatment is needed.

Assuntos

RESUMO

Ante la emergencia de infecciones relacionadas al drenaje ventricular externo por gérmenes multirresistentes y la necesidad de utilizar antibióticos cuya acción en el sistema nervioso central es controvertida, surge la necesidad de emplear terapéuticas para la administración de fármacos cuyos beneficios merecen ser evaluados. Se realizó una búsqueda de la literatura en PUBMED y los datos fueron extraídos de estudios publicados entre 1987-2005. En esta revisión de la literatura se analizaron los resultados obtenidos, comparando: el tratamiento endovenoso con el tratamiento intratecal en pacientes con infección asociada a la ventriculostomía, los antibióticos utilizados y su penetración al líquido cefalorraquídeo (LCR) con cada vía. Finalmente, se propuso qué pacientes podrían beneficiarse con cada terapéutica, a pesar de la falta de evidencias claras, sugiriendo la necesidad de realizar un trabajo randomizado prospectivo comparando sus beneficios. Palabras clave: infección, tratamiento, ventriculitis. (AU)

Due to the emergency of external ventricular drainage infections, cause by multiresistant bacterial strains, and the need to treat them with antibiotics, whose action in the central nervous system is controversial, arises the terapeutic necessity to administer antibiotics whose benefits should be evaluated. We search the Pubmed library. The data were extracted from published studies between 1987-2005. In this reivision the results were analyzed, comparing envovenous versus intrathecal treatment in patients with a ventriculostomy associated infection, the antibiotics that were used and their cerebrospinal fluid (CSF) levels according to each route. Finally, even though there is a lack of clear evidence, we proposed which patients could benefit with each treatment. We conclude that a randomized prospective study, comparing the benefits of each treatment is needed. (AU)

Assuntos

RESUMO

Ante la emergencia de infecciones relacionadas al drenaje ventricular externo por gérmenes multirresistentes y la necesidad de utilizar antibióticos cuya acción en el sistema nervioso central es controvertida, surge la necesidad de emplear terapéuticas para la administración de fármacos cuyos beneficios merecen ser evaluados. Se realizó una búsqueda de la literatura en PUBMED y los datos fueron extraídos de estudios publicados entre 1987-2005. En esta revisión de la literatura se analizaron los resultados obtenidos, comparando: el tratamiento endovenoso con el tratamiento intratecal en pacientes con infección asociada a la ventriculostomía, los antibióticos utilizados y su penetración al líquido cefalorraquídeo (LCR) con cada vía. Finalmente, se propuso qué pacientes podrían beneficiarse con cada terapéutica, a pesar de la falta de evidencias claras, sugiriendo la necesidad de realizar un trabajo randomizado prospectivo comparando sus beneficios. Palabras clave: infección, tratamiento, ventriculitis. (AU)

Due to the emergency of external ventricular drainage infections, cause by multiresistant bacterial strains, and the need to treat them with antibiotics, whose action in the central nervous system is controversial, arises the terapeutic necessity to administer antibiotics whose benefits should be evaluated. We search the Pubmed library. The data were extracted from published studies between 1987-2005. In this reivision the results were analyzed, comparing envovenous versus intrathecal treatment in patients with a ventriculostomy associated infection, the antibiotics that were used and their cerebrospinal fluid (CSF) levels according to each route. Finally, even though there is a lack of clear evidence, we proposed which patients could benefit with each treatment. We conclude that a randomized prospective study, comparing the benefits of each treatment is needed. (AU)

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We studied the penetration of moxalactam into the cerebrospinal fluid of 16 children (age range one month to 4 1/2 years) who were being treated for bacterial meningitis. Two hours after single intravenous doses of 15 or 25 mg/kg, moxalactam was detectable in the CSF in only one of 11 instances; however, following three doses (50 mg/kg each) moxalactam was detectable in eight of 17 instances. In these eight instances CSF concentrations of moxalactam ranged between 1.5 and 18.9 micrograms/ml (mean 7.7) and the CSF/plasma ratio ranged from 2.6 to 36% (mean 17.7). There was no relation between the stage of meningitis or the CSF cell count and the diffusion of the drug into the CSF. However, the diffusion of the drug significantly correlated with the CSF protein content. In view of the unpredictability of moxalactam penetration into CSF, caution should be exercised in using it alone in the treatment of meningitis.

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This study documents an important change in the kanamycin in susceptibilites of Escherichia coli strains cultivated from neonates. Whereas some nurseries have in the past experienced resistance rates as high as 70 per cent recent survelliance of seven North American nurseries demonstrated that 90 percent or more of E. coli strains are currently susceptible to kanamycin. Pharmacokinetic studies of 65 babies treated with either 7.5 or 10 mg/kg kanamycin doses revealed that peak serum values varied with dosage, birthweight, and chronologic age. Peak serum levels were below the desired therapeutic range in many babies treated with 7.5 mg/kg doses of kanamycin every 12 hours. Concentrations in cerebrospinal fluid specimens from 21 infants were 0.5 to 12 mu/ml after 7.5 mg/kg kanamycin doses. Calculated distribution volumes, plasma clearances, and serum half-life values were used in formulating a revised kanamycin in dosage and frequency of administration schedule.

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